Self-rated health and health conditions of married and unmarried men in Jamaica.

BACKGROUND: Since 1988, when Jamaica began collecting data on the living conditions of its people, men have reported seeking less health care than women. Despite this fact, the group has never been studied by researchers. The same is true about the health status of married and non-married men. OBJECTIVES: The current study will 1) evaluate the changing epidemiological patterns of diseases affecting men in Jamaica; 2) determine factors that correlate with good health status of men; 3) compare and contrast the differences in health status of men, in particular marital status; and 4) determine which marital status has the greater health status. MATERIALS AND METHODS: The data for this research were taken from two secondary cross-sectional surveys. A sample of 8,078 respondents 15 years and older was extracted from the 2002 survey (n=25,018 respondents) and 2,224 respondents from the 2007 sample (n=6,783 respondents). SPSS for Windows 16.0 was used to store, retrieve and analyse the data. Chi-square, analysis of variance, t-test and logistic regression were used in this paper. RESULTS: Married men are more likely to report an illness than never married (OR = 1.68, 95% CI = 1.45-1.95), separated, divorced or widowed men (OR = 2.62, 95% CI = 2.06-3.33). No significant statistical difference existed between the self-rated health status of married and unmarried men. CONCLUSION: This study provides a platform upon which future studies can commence as we begin to examine men's health in Jamaica.

A report from rural Costa Rica.

PIP: This report provides findings from interviews conducted among single mothers and other community members from Monteverde, Costa Rica in 1995. Costa Rica has experienced recent, rapid fertility decline. The population still includes 33% who are under 15 years old and capable of adding to population increases. The sample of single mothers includes women who were never married, or those who were divorced, widowed, or separated. This group of mothers contends with primary headship and decision making in family affairs and with social stigma from being single mothers. Many employers discriminate against single mothers in hiring. Single mothers were concerned about making enough money to pay for basic items, such as rent, food, and child care. Some worried about the lack of a father's love and discipline. All sample respondents stated that it was important to plan the number and timing of childbearing. The single mothers were familiar with several modern and traditional methods of contraception. Few pregnancies were planned. Most were mistrustful of the effectiveness and safety of modern contraceptives. The negative attitudes were attributed to religious influences, misinformation, or lack of information. High school sex education provides information about biological reproduction, sexually transmitted diseases, and methods of contraception. One instructor said that she recommends rhythm as the safest and best method. The only other source of information about family planning is the clinic. Little information is directed to unmarried girls and or male responsibility. The community organization that sponsored the survey is working to empower women and decrease social discrimination against single mothers. The author recommends improved information dissemination on sexuality, reproductive health, and contraception and improved access of unmarried teens to contraceptives.^ieng

Chlamydia trachomatis infection among Hispanic women in the California-Mexico border area, 1993: establishing screening criteria in a primary care setting.

BACKGROUND: Chlamydia prevalence and transmission patterns in California-Mexico border communities are unknown, and selective screening strategies for Hispanic populations have not been evaluated. GOAL OF THIS STUDY: To determine chlamydia prevalence among Hispanic women in the California-Mexico border area and established screening criteria. STUDY DESIGN: This was a cross-sectional prevalence survey of family planning/prenatal Hispanic clients (n = 2378) in San Diego and Imperial Counties, California, and Tijuana, Mexico. RESULTS: Overall, chlamydia prevalence was 3.2% (3.3% in California; 2.1% in Mexico). Women born in Mexico or those who visited Mexico for at least 1 week in the recent past had a prevalence rate similar to women without those characteristics. Multivariate analysis showed that young age (less than 25 years old), unmarried status, or having clinical signs of a chlamydia syndrome (primarily cervicitis) or vaginosis independently predicted chlamydia infection. Applying minimum screening criteria recommended by the Centers for Disease Control would require screening less than half of the clients. However, only 69% of infections would be identified. Using survey-based criteria (less than 25 years old, unmarried, and clinical signs of a chlamydia syndrome) would require screening 64% of clients, but would identify 92% of those infected. CONCLUSION: Chlamydia prevalence among Hispanic women seeking reproductive healthcare was similar (< 5%) on both sides of the California-Mexico border. Among Hispanic women, using easily obtained demographic data (age and marital status) and clinical signs (primarily cervicitis), an effective selective screening strategy can be implemented.

PIP: During January 1-October 15, 1993, three clinics in Imperial County, California, located east of the coastal mountain range which borders Baja California; a large community health center in San Diego County, California; and a public health/family planning clinic in Tijuana in Baja California, Mexico, successfully screened 2378 Hispanic women for Chlamydia trachomatis. The overall chlamydia prevalence was 3.2% (2.1% in Tijuana; 3.3% in California). Chlamydia was more common among the prenatal clients than family planning clients (4.7% vs. 2.6%; p 0.02). Adolescents had the highest chlamydia infection rate (7.5%). Women born in Mexico or those who visited Mexico for at least one week during the last three months had a similar chlamydia prevalence rate as those born in the US or those who had not visited Mexico recently. The multivariate analysis revealed that significant independent predictors of chlamydia infection included young age (25 years) (prevalence ratio [PR] = 4.5 for 20 years and 2.5 for 20-24 years), unmarried status (PR = 2), high risk sex behavior (PR = 1.1), exposure to a sexually transmitted disease (PR = 2.6), discharge/bleeding (PR = 1.4), vaginosis (PR = 3.6), and cervicitis (i.e., chlamydia syndrome) (PR = 6). If the clinics had applied the minimum screening criteria recommended by the US Centers for Disease Control, less than 50% of the clients would have been screened. Yet it would have identified only 69% of chlamydia infections. If clinics would apply the criteria identified in this survey, they would need to screen 64% of their clients, which would identify 92% of clients infected with chlamydia. These findings indicate that, in the California-Mexico border region, chlamydia prevalence among Hispanic women seeking reproductive health care was comparable. They also show that clinics can implement an effective selective screening strategy.

[A preliminary analysis of unmarried mothers who were heads of households in Brazil during 1970 and 1980]. / Analisis preliminar acerca de las madres solteras, jefas de hogar, en Brasil durante 1970 y 1980.

"This paper reports on an attempt to use census data from Brazil in 1970 and 1980 to investigate a rise in household headship by unmarried mothers 15-49.... Demographic analysis can be useful in decomposing the change into that due to a changed propensity of women 15-49 years of age to be unmarried, to have children if unmarried, and to head their own household if an unmarried mother. This was further analyzed in terms of age, marital status (whether single, divorced/separated or widowed), region of residence, and urban-rural status....However, the research encountered data problems that make firm conclusions impossible...." This is a translation of a paper originally presented at the 1992 Annual Meeting of the Population Association of America. (SUMMARY IN ENG)

The ethnographic context of illness among single-women-headed households in rural Peru.

Peru is undergoing many deleterious economic and social changes, and the health consequences for families headed by single women is of special concern. However, not all single mothers' families may be at similar risk of morbidity. My purpose in the present study was to determine whether variation in illness prevalence was associated with ostensibly small differences in socioeconomic resources and physical living conditions in areas like Peru. I used both qualitative and quantitative methods in this study. The sample included single-women-headed households from the rural Nuñoa District, located in the southern Peruvian Andes (N = 22 families with 90 individuals). Quantitative cross-sectional survey results suggested that the mother's formal education, the availability of a latrine, drinking water contamination, the gender ratio of the household, and the quality of the social support network were key risk factors. They statistically predicted 35-91% of the morbidity variance between families (p < or = .03-.0001). I illustrate these findings in three ethnographic case studies. The case studies show how the degree of illness among single-women-headed families was affected by small differences in their social and physical living conditions.

PIP: The purpose of this study was to determine whether illness prevalence was associated with small differences in socioeconomic and living conditions in the Nunoa District of Peru where 9800 people lived. Between 1960 and 1984, the average annual infant mortality rate was 134.8 deaths/1000 live births. The focus was on single mothers and their families in the town of Nunoa and in a clan village called Sincata. In the town, mean household size was 5.2 (SD=1.9) persons. In Sincata, families were smaller, with an average of 4.9 (SD=2.3) persons. Single women generally had smaller families. Formal education for adults in the town averaged 6.4 (SD=2.4) years. Adults in Sincata had only 3.8 (SD=2.3) years of education. Representative Nunoa (n=96 families, totaling 371 persons) and Sincata (n=25 families, totaling 110 persons) samples were obtained. Of the 121 households, 22 were headed by single mothers. The structured interview responses regarding individual illnesses, demographic characteristics, socioeconomic circumstances, and physical living conditions were analyzed by correlation and multiple regression statistics. The use of a latrine, the level of the mother's formal education, the source of drinking water, and the household sex ratio together predicted 91% of the variance in reported symptom levels. Illness duration was correlated with mother's education (p=.0007). Mother's education also was connected to a disruptive effect of illness on work (p.0014). Variance in household child stature for age was strongly predicted by drinking water source and social support network quality (p0014). Water source alone predicted 35% of weight-for-age variance (p=.03). The social resources of the mother and the physical living conditions statistically predicted 35-91% of the morbidity variance among single-women-headed families (p=.03-.0001). These findings are illustrated in three ethnographic case studies.

Mexican agencies reach teenagers.

PIP: The Gente Joven project of the Mexican Foundation for Family Planning (MEXFAM) trains young volunteers in 19 cities to spread messages about sexually transmitted diseases and population growth to their peers. They also distribute condoms and spermicides. It also uses films and materials to spread its messages. The project would like to influence young men's behavior, but the Latin image of machismo poses a big challenge. It would like to become more responsible toward pregnancy prevention. About 50% of adolescents have sexual intercourse, but few use contraceptives resulting in a high adolescent pregnancy rate. Many of these pregnant teenagers choose not to marry. Adolescent pregnancy leads to girls leaving school, few marketable skills, and rearing children alone. Besides women who began childbearing as a teenager have 1.5 times more children than other women. Male involvement in pregnancy prevention should improve these statistics. As late as 1973, the Health Code banned promotion and sales of contraceptives, but by 1992 about 50% of women of reproductive age use contraceptives. The Center for the Orientation of Adolescents has organized 8 Young Men's Clubs in Mexico City to involve male teenagers more in family planning and to develop self-confidence. It uses a holistic approach to their development through discussions with their peers. A MEXFAM study shows that young men are not close with their fathers who tend to exude a machismo attitude, thus the young men do not have a role model for responsible sexual behavior. MEXFAM's work is cut out for them, however, since the same study indicates that 50% of the young men believe it is fine to have 1 girlfriend and 33% think women should earn more than men. A teenager volunteer reports, however, that more boys have been coming to him for contraception and information than girls in 1992 while in other years girls outnumbered the boys.^ieng

[Nuptiality trends and the fertility transition in Latin America]. / Las tendencias de la nupcialidad y la transicion de la fecundidad en America Latina.

The author uses census data to examine the impact of nuptiality on the fertility transition in Latin America. He finds that fertility decreased among adolescents during the 1960s, although no trend was observed for later decades. However, "an increase of legal marriages in connection with consensual unions was also observed. Apart from an [increase] in the number of illegitimate children, the impact of the increase of consensual unions upon fertility is uncertain. No regional trend was observed in connection with age at marriage. This stability suggests that Latin American patterns of marriage are determined by cultural factors rather than socioeconomic reasons." (SUMMARY IN ENG)

Between hearth and labor market: the recruitment of peasant women in the Andes.

PIP: To cover subsistence requirements, peasant women from the Peruvian Andes increasingly are being forced to engage in income-generating activities, including domestic service, marketing, manufacturing, and herding. In many cases, recruitment into waged labor involves migration from rural communities. Case studies of the placement of peasant women in external labor markets illustrate the complex micro- and macro-level factors that determine the mix of productive and reproductive labor. The sexual division of labor in the domestic economy and community is the critical in regulating the length of absence of peasant women from the home, the types of jobs taken, and the migratory destination. In 1 such case study, 56 women from the village of Kallarayan (all of whom had migrated at some point) were interviewed during 13 months of fieldwork in 1984-85. There is no paid employment in Kallarayan, so 14% of the village's population is involved in migration to urban areas or commercial agricultural areas in jungle valleys at any point. Male migration is high in the 11-40-year age group, but becomes seasonal once men marry. Female migrants tend to remain away from the village for longer periods, but are almost exclusively single. Recruitment of peasant women into paid labor is achieved by 5 types of agents: family, godparents and friends, authority figures, recruiting agents, and employers. Peasant girls under 15 years of age tend to be allocated to external labor markets (largely domestic services) by parents and godparents; after 15 years, however, when children are considered to reach adulthood, there is a shift toward self-motivated migration or recruitment by employers and agents. The eldest daughter typically enters migration at age 14 years and sacrifices her education, while younger siblings remain in the home longer. In all but the poorest families, female migration for waged labor ends with marriage.^ieng

[The fertility of Mexican adolescents. Cultural and health problems]. / La fecundidad de las adolescentes Mexicanas, problems cultural y de salud

PIP: During the past years Mexico has faced a growing problem among teenagers. 15% of all births are to teen-age mothers. A large proportion of women who get pregnant during their adolescence are forced to face 3 options: 1) marriage; 2) have the baby without marriage; and 3) an abortion. Since abortion is illegal and limited in Mexico, most teenage mothers either live with the father or remain a single parent for may years. According to the 1987 Health and Fertility Survey, 37% of children of mothers under 15 were conceived by single women. This % increases with age reaching 18% among women who had their 1st child between 20-24. In spite of the gravity of the problem, there has been a decline in the % of women having children before 20; a decline of 40% for women born between 1935-1940 and 35% for those born between 1960- 1965. National survey data demonstrate educational differences between women who attended school as against those that did not: 60% of illiterate women had their 1st child during adolescence as against 10% of women with some secondary schooling.^ieng

[Adolescent pregnancy, a public health problem]. / Embarazo de adolescentes, problema de salud publica

PIP: Throughout Western civilization the fundamental unit of society is the family. The union of a couple guarantees their responsibility to future children. Prior to the renaissance, when life expectancy was very low, the preservation of the human species required reproduction at a young age. Since the beginning of the 19th century, life expectancy has increased greatly. The extremes of reproductive age have been noted to be times when pregnancy carries increase risks, and the risks of grand multiparity have been noted. The sexual revolution has resulted in the loss of previous principles of conduct. Youth are incited by pornography in the media, and without the controlling influence of the traditional family, become sexually active at a younger age. In Chile, as elsewhere, there have always been out of wedlock births, but in 1970 these reached 18.5% of all births. By 1980, it had reached 27.6% of all births and 45.7% of births to mothers under age 20. Since the family is the basic unit of society, this number of illegitimate births indicates a grave social problem. This also represents a public health risk due to the increased risks of young mothers. Illegitimate children of adolescent mothers have the added problem that the fathers are usually also young, so both parents are still in school and cannot assume full responsibility for the child. These babies have a much higher infant mortality than those of older mothers. The only solution is education, and legislation requiring paternal responsibility. School teachers often have an inadequate knowledge of reproduction and sexuality, and can not serve as sources of information to the students. Without supportive education and legislation requiring both parents to be responsible for their children, we will not be able to solve this situation.^ieng

[Pregnancy in the adolescent. III. Comparative study between primipara from 18 to 19 years old]. / Gravidez na adolescencia. III. Estudo comparativo entre primiparas de 18 a 19 anos.

PIP: Not all pregnancies are subject to the same risks. Many factors are considered risks, some inherent in the individual, others dependent on the environment (e.g., social maladjustment, socioeconomic level, nutritional deficiency). These factors can act alone or synergistically. Physicians agree that pregnancy in adolescence runs a very high level of risk. They do not agree, however, on the upper age limit of this high risk group. To explore this area, the authors studied 209 primiparous adolescents who gave birth at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, between January 1975 and June 1980. Patients were divided into 2 groups: Group 1 consisted of 105 women 18 years old, and Group 2 was composed of 104 women 19 years old. 68 patients (64.8%) in Group 1 were unmarried while 14 patients (13.4%) were unmarried in Group 2. Prenatal care was considered inadequate (less than 5 visits) in 70.5% of Group 1 and 54.8% of Group 2. Pregnancy complications in both groups were recorded, with arterial hypertension occurring in 49% of Group 1 and 30.4% of Group 2. Urinary infections (14.3% in Group 1, 17.3% in Group 2) and anemia (14.3% of Group 1, 15.5% of Group 2) were the 2nd and 3rd most frequent complications observed. Fetal presentation, length of labor, use of forceps, and cesarean deliveries were also recorded for both groups. Birth weight, Apgar scores, and perinatal mortality showed no significant differences between the 2 groups. Results of the study indicate that there are no important differences between the pregnancies of 18 and 19 year old adolescents, although the 18 year olds more frequently received inadequate prenatal care. Clinical complications were similar to those of all adolescents in general, with a much higher rate of urinary infection than in adult pregnancies. The authors conclude that 18 and 19 year old parturients present a maturity similar to that of adults despite maintaining some of the same characteristics as adolescents.^ieng

[Pregnancy in the adolescent. IV. Borderline reproductive age risk among adolescents]. / Gravidez na adolescencia. IV. Idade limite de risco reprodutivo entre adolescentes.

PIP: This study examined the cases of 557 primiparous adolescents, between the ages of 9 and 19, who gave birth at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, from January 1975 to June 1980. During this period 13,961 deliveries took place, producing an adolescent pregnancy incidence of 3.9%. Based on previous work, 2 groups were established: Group I, composed of 242 women aged 9 to 16, and Group II, composed of 315 women aged 17 to 19. The greatest number of unwed mothers occurred in Group I, the younger age group (98.4%), compared to 54.3% in Group II. An important characteristic in the younger age group was lack of adequate prenatal care. In Group I only 12% received adequate prenatal care, while in Group II, 28.6% received adequate care. Clearly the greatest frequency of prematurity was in the younger group (28.1% of Group I vs. 12.4% of Group II), along with a higher rate of perinatal mortality (4.9% in Group I vs. 2.5% in Group II). Cases of eclampsia occurred more frequently in the younger adolescents (3.3% of Group I vs 1.6% of Group II), but hypertension was more prevalent among the older adolescents (35.9% in Group II vs. 22.7% in Group I). The authors conclude that during pregnancy all adolescents reach similar biologic and endocrine maturity and display similar obstetric performance. The less satisfactory performance among patients in Group I is primarily due to socioeconomic conditions, inadequate resolution of problems related to acceptance of pregnancy, lack of family support, and inadquate prenatal care. The authors believe that the risks associated with adolescent pregnancy could be substantially reduced if adolescents were better informed and received psychological support and adequate prenatal care.^ieng

[Pregnancy in the adolescent. I. Primigravidas of 9 to 15 years old]. / Gravidez na adolescencia. I. Primigestas de 9 a 15 anos.

PIP: From January 1975 to June 1980, 13,951 births took place at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil. Of these births, 105 (0.7%) were 1st births to adolescents between the ages of 9 and 15. 92.3% of the adolescents were unmarried, indicating that they failed to use adequate methods of birth control. 89.5% of the adolescents did not receive adequate prenatal care, contributing to the high incidence of complications during the pregnancy-puerperal cycle. Among complications occurring during pregnancy, the most common were toxemia (29.5%), urinary infection (16.1%), and anemia (8.5%). Premature birth took place in 30.5% of the adolescent pregnancies, a rate a prematurity greater than in the general population. Analgesia at birth was necessary in 20.9% of the cases. This tendency was more a consequence of nulliparity and emotional factors than of age of patient. Contrary to expectations, cesarean sections were required with no greater frequency than in the general population. Complications in birth and puerperium did not differ from patients in general. No cases of fetal death occurred; neonatal deaths occurred in 5.5% of the cases, the consequence of prematurity. Jaundice occurred as the most frequent complication in newborns (70.0%); no cases of serious malformations were observed.^ieng

[Pregnancy in the adolescent. II. Comparative study between primigravida from 9 to 15, 16 and 17 years old]. / Gravidez na adolescencia. II. Estudo comparativo entre gestantes de 9 a 15 anos, 16 e 17 anos.

PIP: This paper presents a study of adolescent pregnancy in which different age groups were compared to establish which age group had the greatest incidence of risk factors. Primiparous adolescents who delivered at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, between January 1975 and June 1980 were studied. During this period, 13,961 births occurred, of which 105 were to 9-15 year olds (0.7%), 137 were to 16 year olds (0.9%) and 106 were to 17 year olds (0.7%). A large majority of the adolescents in each age group were unmarried; similarly, a lack of adequate prenatal care was observed in all 3 groups. A gestational age of less than 38 weeks was encountered in 30.5% (30 cases), and 16.9% (18 cases), respectively, in the 9-15, 16, and 17 year age groups. Among pregnancy complications, there was an elevated incidence of arterial hypertension in all 3 groups, as well as an increased occurrence of eclampsia among the 9-15 year olds. Urinary infections and anemia were also evident during pregnancy. Analgesia was required in 22 cases (20.9%) of the 9-15 year old age group, in 3 cases (2.2%) of the 16 year age group, and in 2 cases (1.9%) of the 17 year age group. Fetal presentation, duration of labor, type of birth (normal, forceps, or cesarean), puerperal morbidity, birth weight, and perinatal mortality for each of the 3 groups are presented in tables. Neonatal deaths were determined to be the consequence of prematurity and its complications except in 1 case of congenital heart disease which occurred in the 17 year old group. Neonatal jaundice was the most frequent cause of morbidity in the newborns. The results of this study agree with those of similar studies appearing in the literature. The authors attribute the greater frequency of premature births among 9-16 year olds to immaturtity of uterine muscle fiber, deficient prenatal care, and the emotional tensions to which the adolescents were subjected, as well as to medical complications of pregnancy and general maternal physical immaturity. The 17 year olds presented behavior closer to that of the adult population.^ieng

Pregnancy and motherhood among Mexican American adolescents.

PIP: The influence of acculturation among Mexican American adolescents was examined in reference to attitudes toward pregnancy and motherhood, contraceptive and reproductive knowledge, and the role of family and peers both as behavioral models and as support networks. Data were collected by administering questionnaires to 122 adolescent participants of the Los Angeles County Supplementary Food Program for Women, Infants, and Children. The adolescents were either pregnant or had given birth to a child during the previous 12 month, 2 age cohorts were analyzed. 61 teenagers werein the 13-17 year cohort, and 61 were in the 18-20 year cohort. Each cohort was further subdivided into the 3 categories of less accultured Mexican Americans more acculturated Mexican Americans, and white non-Hispanics. Respondent's predominant use of either Spanish or English was usedto categorize by acculturation level. The 6 subgroups resulting from the age and cultural classifications were compared with reference to demographic characteristics, social networks, contraceptive knowledge and usage, and fertility knowledge. Most of the adolescents in each subgroup lived inhouseholds with annual incomes of less than US $5500, but the proportion of less acculturated Mexican Americans, aged 13-17, living in low income households was higher (82.4%) than for the other subgroups. The less acculturated Mexican Americans in both age groups were more likely to follow the Mexican tradition of marrying if a pregnancy occurred. The percentage among the less acculturated group was 47.4% for those aged 13-17 and 85.0% for those aged 18-20. Respective proportions were 22.7% and 61.9% for the more acculturated group and 0.0% and 45.0% for the non-)hispanic group. Less acculturated Mexican Americans were more likely to discontinue their schooling when they became pregnant than other adolescents. Adolescents in all subgroups tended to come from families which exerted little parental control over adolescent dating behavior. Most of the adolescents in each subgroup relied most heavily on their mothers for emotional support; however, the less acculturated adolescents relied less heavily on their mothers because their mothers frequently resided in Mexico. The less acculturated teenagers relied much less on peers for support than the other subgroups and were somewhat isolated from peer contact. The more acculturated Mexican Americans exhibited a number of traits indicative of adolescents in conflict. They were more knowledgeable about reproduction than other subgroups, but they were less likely to use contraceptives than the other groups. They were also more likely to reject parental guidelines and to have a higher proportion of unplanned pregnancies than the other groups. Findings indicate that acculturation levels should be taken into account in counseling Mexican American adolescents. For less acculturated teenagers, efforts should be made to create a support network of peers and family substitutes. More acculturated teenagers need greater access to contraceptives, and social workers should encourage the members of the adolescent's social network to provide additional support and understanding.^ieng

Illegal abortion in Latin America.

PIP: In Latin American countries abortion on demand is legal only in Cuba and must be performed there in hospitals within the 1st 12 weeks of pregnancy. After the 1st trimester, it can be performed only for medical reasons. With regard to the other 18 Latin American countries, abortion is illegal in 2 of them even for saving the life of the pregnant women. In 9 countries therapeutic abortion is permitted only to save the woman's life. It is allowed in 4 countries in the case of severe disease that will be aggravated if the pregnancy continues. In the 3 remaining countries, in addition to medical reasons, it is legal if pregnancy is the consequence of incest or rape. Despite the law, induced abortion is often performed. The complications of illegal abortion are reviewed along with mortality and morbidity and abortions in adolescents. In Colombia in 1974, 58,717 women were hospitalized for complications of abortion. 42,160 women were hospitalized in Chile in 1974 with the same diagnosis. As Colombia and Chile both have family planning programs and effecive contraceptives are easily obtained, the rate could be even higher in those countries without programs or contraceptive availability. From surveys conducted in these 2 countries, it may be concluded that only 1 out of 3 induced abortions is complicated and requires hospitalization. The hospitalization for complications of abortion/1000 women of fertile age in Colombia and Chile suggests that there is an annual average of 15 hospitalized cases/1000 women of fertile age throughout Latin America. Presuming reasonable accuracy for these surveys, the rate of induced abortion in the entire continent can be estimated to be at least 45/1000 women of fertile age. From this, without considering Cuba, a conservative estimate of 3.4 million illegal induced abortions are performed annually in Latin America. It seems that illegal abortions are performed at an even higher rate than that observed in countries where abortion is legal and effective contraceptives are easily available. According to Tietze, in the U.S. between 1968 and 1972 the case fatality rate from legal abortion was only 0.1/million. When it is performed illegally in pregnant women who cannot pay a competent professional, the case fatality rate in Chile, considering only women who died in hospital, is 100 times greater and represents 38% of total maternal deaths. The treatment of complicated cases also represents a high cost for the hospitals. In the hospitals, the proportion of complicated abortions in women under age 20 is usually low; it varies from 11-20%. Chilean statistics show that in 1980 a total of 26.8% of births were illegitimate, and among those born to mothers under age 20 this was 44.1%. Needed are epidemiological studies on an international basis that would allow comparability and show ways to prevent the adverse consequences of illegal abortion.^ieng

[Epidemiology of hospitalized abortion in Valdivia, Chile (author's transl)]. / Epidemiología del aborto hospitalizado en Valdivia.

PIP: The impact of the Family Planning Program established in Valdivia in 1964 has been important in the decline of abortion and its rate/1000 women of fertile age during 1980 is the most remarkable in the last 21 years. Epidemiological characteristics of our patients, studied prospectively on standard forms prepared by the International Fertility Research Program, North Carolina, and used in all women hospitalized for abortion in the Regional Hospital of Valdivia over a 16-month period who were elected at random, shows that most of them were married legally or by common law. However, between unmarrieds, the possibility of an induced abortion is higher and 61.2% of them reported abortions induced outside the hospital, while among marrieds, this only occurred in 26.0%. Most of the women were well-educated, with the mean being 8.6 years; 11.3% had university educations, and only 3.1% were illiterate. The education and the number of living children (mean 1.7) does not appear to have a significant bearing on the likelihood of inducing illegal abortion and we believe that other events seem to be more significant at this time. More than 1/2 of the 218 women with induced abortions (54.5%) relapsed and there were 2 deaths as a result of complications of induced abortions performed outside the hospital. We emphasize the need for a revision of our programs and the adoption of some other type of health policy aimed at the global attention of unmarried women. (author's)^ieng

[Fertility and youth]. / La fecundidad y la juventud.

PIP: This work examines the history and current characteristics of fertility among Cuban women aged 15-24 and speculates on the determinants of fertility patterns among them. Cuban fertility has tended in different periods to peak at an early age, with the modal age of giving birth in the 20-24 group. The level of fertility was high from 1955-59, increasing slightly in the 1st years after the Revolution and beginning to decline again in the mid 1960s. Age specific fertility rates still showed peak fertility at the younger cohorts. Cuba remains unique among low fertility countries in having such a high fertility rate among young women aged 15-19. The fertility of women aged 20-24 began to decline in the late 1960s but that of women 15-20 continued to increase until the early 1970s. Age specific fertility rates for the cohort aged 20-24 declined by 45.5% between 1975-78 while that for women aged 15-19 years declined by 71.1%. The proportion of births to women under 20 has increased due to the fertility decline at older cohorts despite the reduced rate of early fertility. The basic causes of early marriage and elevated fertility among the young have been the greater freedom of youths and the strengthening of matrimony and parental responsibility in conjunction with persistent false moralistic concepts within families and a lack of sex education.^ieng

Malnutrition among babies born to adolescent mothers.

PIP: More than 1/2 the population of Jamaica was under age 20 in 1970. The birth rate for this age group has been increasing in contrast to the trend among other groups. 1 of the problems of adolescent fertility, malnutrition in the children, was examined through a study of the social and economic variables affecting malnourished children born to adolescent mothers. The study sample was taken from the 1521 protein-calorie malnutrition cases admitted to the Bustamante Hospital for Children in Kingston and the University Hospital of the West Indies during the 1967-76 period. Of the 761 babies in the study, 124, approximately 16%, were the offspring of unmarried mothers aged 20 or less. Infant nutrition practices in general were inadequate. 42% of the young mothers had breast fed their infants for 3-6 months, either partially or fully. Supplementation was given with no regard to nutrition. The extent of breast feeding even declined during the 10-year period. There was a clear relationship between the length of breast feeding and the age at 1st admission to the hospital for malnutrition. The economic stresses to which young mothers were exposed appear to be greater than normal. Unemployment was over 82% among the adolescent mothers. Support from the fathers was variable. Single fathers were more likely to support their children than those in multiple father situations.^ieng

[Patterns and trends in nuptiality and some fertility characteristics]. / Padroes e tendencias da nupcialidade e algumas caracteristicas da fecundidade

PIP: Tabulated data and an analysis of changes in marriage patterns in Brazil are presented for the period 1940 to 1970. Particular attention is paid to changes in age at first marriage and to the number of unmarried women in the age groups 20-24 and 40-44. Data are presented by state and federal district, and some comparative data from other countries are included. The effects of the different types of conjugal union on various factors, including fertility, are also analyzed.^ieng